Anormal Plasental İnvazyonda Anestezi Yönetimi

Anormal plasental invazyon (APİ) perpartum hemorajinin önemli ve sık görülen nedenlerinden biridir. Maternalmorbidite ve mortalite, özellikle plasentanın uterustan ayrılma girişimleri sırasındaki masif kanamaya bağlıdır. APİ’deiyi belirlenmiş risk faktörleri tanı koymada yardımcıdır. Daha önce geçirilmiş sezeryan ve mevcut gebelikteki plasentaprevia majör risk faktörlerini oluşturmaktadır. APİ’si olan hastaların perioperatif yönetiminde; anestezist, kadınhastalıkları ve doğum uzmanı, girişimsel radyolog ve kan merkezi sorumluları arasında yakın bir koordinasyongerekmektedir.Derin hipotansiyon ve koagülopati ile komplike olabilen masif kanama riski ve sezaryen sırasında histerektomi olasılığınedeniyle, APİ’si olan hastalarda genellikle genel anestezi tercih edilmektedir.Cerrahi, farmakolojik ve transfüzyon yaklaşımlarını kullanarak planlanmış bir kanama protokolü, APİ ile ilişkilimorbidite ve mortaliteyi azaltmada yardımcı olmaktadır.Bu derlemede anormal plasental invazyonu olan hastanın perioperatif anestezi yönetiminden bahsedilecektir.

Anesthetic Management in the Abnormal Placental Invasion

Abnormal placental invasion (API) is one of the causes of peripartum hemorrhage. API associated maternal morbidity or mortality is mainly due to massive hemorrhage, in particular after attempts at forced manual removal of the placenta. Several risk factors for API are known and may lead to the diagnosis. Previous cesarean section and placenta previa in present pregnancy constitute major risk factors for API. The perioperative management of patients with API requires close coordination amongst anesthesiologists, obstetricians, interventional radiologists and blood bank providers. Due to the significant risk of massive bleeding complicated by profound hypotension and coagulopathy and a high likelihood of hysterectomy during cesarean delivery, general anesthesia is generally regarded as the anesthetic choice for patients with API. A well-organized hemorrhage protocol using surgical, pharmacologic, and transfusion approaches has an important role in decreasing the morbidity and mortality associated with API. In this review, the perioperative anesthesia management of a patient with abnormal placental invasion will be described.

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